Comprehensive AOCMF Classification System. Cornelius CP, Kunz C, Prein J, Audigé L. Mandibular fractures Level-2 system (cases 1 to 18)

Transcription

1 Comprehensive AOCMF Classification System Cornelius CP, Kunz C, Prein J, Audigé L Mandibular fractures Level-2 system (cases 1 to 18)

2 Case 1: Body fracture traversing anterior transition zone Imaging: 3 D Reformatted CT scans (surface rendering): anterior oblique view, oblique basal view with making of anterior transitional zone, basal view, inside (lingual) view. Description: Oblique fracture starting in interdental space between lateral lower incisor and canine, travelling back and downwards across the transitional zone. Lingual view confirms the course of the fracture line over the transitional zone. Level 2 Code: 91 m.b AOCOIAC case CMTR

3 Case 2: Body region fracture Imaging: Panorama x-ray Description: vertical fracture line along the periodontium of first molar to inferior mandibular border. Level 2 Code: 91 B.m AOCOIAC case CMTR

4 Case 3: Angle fracture in posterior transition zone Imaging: Panorama x-ray, a.p.15 -Clementschisch Description: Description: Vertical fracture line just behind the posterior transition zone on the left. The wisdom tooth (38) is involved. Level 2 Code: 91 m.a AOCOIAC case CMTR

5 Case 4: Fracture fully within posterior transition zone Imaging: Panoramic x-ray Description: Almost vertically running fracture within the posterior transition zone on the left, transsecting the root bifurcation of the wisdom tooth (38). Level 2 Code: 91 m.a AOCOIAC case CMTR

6 Case 5: Horizontal angle / ramus fracture Imaging: Panorama x-ray Description: Single horizontal fracture within the angle / ramus region on the left side Level 2 Code: 91 m.a AOCOIAC case CMTR

7 Case 6: Vertical angle / ramus fracture Imaging: 3D CT reformation Description: A vertical fracture line running from the coronoid process to the inferior border of the mandible. The fracture does not separate the coronoid process from its base. Therefore it is not classified as a coronoid fracture. It corresponds to a typical vertical ramus fracture, which is encompassed in the angle/ ramus region. Level 2 Code: 91 m.a AOCOIAC case CMTR

8 Case 7: Isolated coronoid fracture Imaging: CT Scans coronal, sagittal, axial, 3D Reformation: volume and surface rendering Description: single fracture line separating the coronoid process on the left from its base. Level 2 Code: 91 m.c AOCOIAC case CMTR

9 Case 8: Condylar process fracture Imaging: CT Scans coronal, axial. 3 D Reformation volume rendering Description: Fracture line running through the base of the condylar process on the left side (Level 3). The small fragment is laterally displaced (lateral override) and angulated medially. The bony contact between the fragments is not completely lost. The condylar head is orthtotopically distorted within the fossa. Level 2 Code: 91 m.p AOCOIAC case CMTR Level 3 P (left) Code: B0

10 Case 9: Double fracture of the mandible Imaging: Panoramic X-ray Description (Level-2): Double fracture of the mandible - Condylar process fracture with displaced fragment of the condylar head on the right, and symphyseal fracture, with vertical fracture line within the symphyseal region extending from the interdental space between he medial and lateral incisors (21/22) to the inferior mandibular border. Level 2 Code: 91 P.S AOCOIAC case CMTR

11 Case 10: Double fracture Imaging: 3D CT Reformation Description: Double fracture of the mandible - Angle / ramus fracture with fracture line from the retromolar area on the right downward to the inferior border within the posterior transition zone, and body fracture with oblique fracture line across the anterior transition zone on the left. Level 2 Code: 91 A.m.B AOCOIAC case CMTR

12 Case 11: Multifragmented fracture within right ascending ramus with condylar process involvement Imaging: 3D CT Reformations of mandibular ramus on the right (lateral view, anterior view, inside view) coronal CT scan at midlevel of the ramus Description: Multifragmentation within right ascending ramus. One fracture line separates the condylar process at its base from the ramus Level 2 Code: 91 P.C AOCOIAC case CMTR

13 Case 12: Triple mandibular fracture (1) Imaging: Panoramic xray, 3D reformatted CTs, sagittal CT slices at the level of the right condylar process Description: Fracture one: Fracture line from the (sigmoid) mandibular notch on the right running backwards along the base of the condylar process to the outer angle - angle/ ramus. From a functional view point it can be regarded as condylar process fracture. Fracture two: Fracture line extending from the toothless molar area on the right posteriorly downward crossing the posterior transition zone and ending in the inferior border of the angle. Basal wedge at the lingual aspect. Fracture three: Fracture line from the posterior aspect of 35 to lower mandibular border - body fracture.

14 Level 2 Code: 91 A-B.m.B AOCOIAC case CMTR

15 Case 13: Triple mandibular fracture (2)

16 Imaging: Panoramic x-ray and CT scans (3D Volume Rendering, MPR coronal, sagittal right, MPR sagittal left, 3D Surface Rendered Views) Description: Fracture one: Fracture starting from the anterior part of the sigmoid notch separating the base of the condylar process in a rectangular fashion - condylar process fracture. Fracture two: Fracture line running from the interdental space between the medial and lateral incisors on the right (41/42) halfway vertically downward into the anterior transition zone - symphyseal fracture. Fracture three: Oblique fracture from the left retromolar area to the outer angle - angle fracture. Level 2 Code: 91 P.S.A AOCOIAC case CMTR

17 Case 14: Triple mandibular fracture (3) Imaging: 3 D CT Reformations Description: Fracture one and three: Sagittal frature line separating the condylar head including the pole zone on the right and left (condylar head bearing fragments in red) - level 2: bilateral condylar process fractures. Fracture two: vertical midline fracture - symphyseal fracture. Level 2 Code: 91 P.S.P AOCOIAC case CMTR

18 Case 15: Multiple mandible fractures Imaging: 3 D CT Reformations Description: Panfacial fracture with multiple fractures in the mandible: condylar process right, angle/ramus right, symphysis contiguous with the body on the left, coronoid process left and condylar process left. Level 2 Code: 91 P.A.S-B.C.P AOCOIAC case CMTR

19 Case 16: Mandibular fracture within the posterior transitional zone Imaging: 3D CT Reformations Description: Oblique fracture line from the tooth gap anterior to the second molar downwards and backwards into the posterior transition zone on the left. - body fracture Level 2 Code: 91 m.b AOCOIAC case CMTR

20 Case 17: Condylar process fracture on edentulous mandible Imaging:Panoramic x-ray and 3D CT Reformations Description: Fracture from sigmoid notch posteriorly downwards within the condylar base (Level 2) Level 2 Code: 91 m.p AOCOIAC case CMTR

21 Case 18: Mandibular body fracture Imaging: 3D CT Reformations Description: Sagittal fracture reaching from the lower canine on the outer table to the molar area on the inner table. Body fracture (Level 2). Level 2 Code: 91 m.b AOCOIAC case CMTR